Final: Glaucoma part 3 Flashcards
What are the adrenergic agonists that lower IOP?
Apraclonidine (Iopidine)
Brimonidine (Alphagan-P)
What are the 2 topical carbonic anhydrase inhibitors(CAI’s)?
Brinzolamide (Azopt)
Dorzolamide (Trusopt)
What are the 2 oral carbonic anhydrase inhibitors(CAI’s)?
Acetazolamide (Diamox)
Methazolamide (Neptazane)
What carbonic anyhydrase inhibitor to optometrists use most often?
Oral Acetazolamide (Diamox)
What two medications are in the combo drop Simbrinza?
Brinzolamide (topical CAI) and Brimonidine (alpha agonist)
What alpha agonist is the most highly selective for alpha 2 receptors which makes it more effective?
Alphagan (brimonidine)30x more than Iopidine (apraclonidine)
What is the primary and secondary MOA for alpha agonists?
Primary: Reduce aqueous production by stimulating alpha 2 receptors.
Secondary: Slight increase in uveoscleral outflow.
What is Iopidine (apraclonidine) derived from? Who is it contraindicated in? What is the onset of action? When is the max IOP reduction?
Derived from oral clonidine which is HTN drug.
Contraindicated in patients with hypersensitivity to clonidine, patients taking MAOIs.
Onset of action in one hour, good for office emergencies. Max effect in 3 hours.
When would we use Iopidine?
How much decrease in IOP?
Control/prevent post-surgical elevations in IOP or if patient has emergency high IOP because it works in 1 hour. Can also be used as additive therapy BID for chronic glaucoma and need something else.
Used to diagnose Horner’s Syndrome. Will reverse the ptosis.
20-30% decrease
How many patents have allergic when using Iopidine? If used chronically, what percent have allergic reaction?
20% immediate reaction
50% if chronic use.
What are 4 systemic side effects of Iopidine?
Dry mouth
Drowsiness
Bradycardia
Nasal decongestion
What are 4 ocular side effects of Iopidine?
Allergic Reaction
Conjunctival blanching
Eyelid Retraction
Mydriasis
What alpha agonist do optometrists use by far?
Alphagan (Brimonidine)
What preservative does brimonidine have?
BAK
What FDA category is Alphagan (brimonidine)
FDA category 2
What percentage is CURRENT Alphagan P?
0.1% brimonidine
What are some clinical uses of Alphagan (brimonidine)?
What percent decrease in IOP?
What is the dosing as a drop by itself?
What is the dosing if added to something else?
Primary open angle glaucoma
Ocular hypertension
26% decrease
TID by itself
BID with other drug
What is a different ocular side effect does brimonidine have compared to iopidine (apraclonidine)?
Brimonidine causes miosis (shrinking of pupil) rather than mydriasis
What medication does Lumify have in it?
Brimonidine.
Causes vasoconstriction and can last hours. Doesn’t have enough concentration to affect IOP.
What alpha agonist can you use for better night vision?
Brimonidine (Alphagan)
Since it shrinks pupil size, it helps at night.
When is Alphagan (Brimonidine) contraindicated?
Less than 2 years old.
Contraindicated in MAOIs and tricyclic antidepressants.
Sever cardiovascular disease and vascular insufficiency.
What two drugs does Simbrinza have in it?
Brimonidine (alpha agonist) and Brinzolamide (CAI)
What are CAI approved for?
Open angle glaucoma
Ocular hypertension
What CAI is a suspension and must shake before using?
Azopt (brinzolamide)
What percent decrease in IOP for CAI?
15-20%
If using CAI by itself, what is dosing regimen? If used with another treatment?
By itself, TId
With other drug, BID
What two meds are in Cosopt? What percent IOP decrease? What is the dosing? Is it available for preservative free?
Cosopt= timolol and dorzolamide
27% decrease in IOP
BID dosing
It is available in preservative free (cosopt PF, single until dose)
What percent decrease in Azopt (brinzolamide)?
What is the dosing?
Is it solution or suspension?
Is it more or less comfortable than Trusopt?
15-20%
BID/TID are equivalent
Suspension
More comfortable than Trusopt
What glaucoma med is a great add on with prostaglandin?
CAI, rarely used by itself
What is the 1st combo drop that does not have a beta blocker? Is it solution or suspension? What is the dosing by itself and as adjunct therapy?
Simbrinza (brinzolamide and brimonidine)
Suspension due to brinzolamide
TID by itself, BID as adjunct
What combo drop would you use for glaucoma if the patient has asthma or congenital heart failure?
Simbrinza (brimonidine and Brinzolamide)
What are 5 ocular side effects with topical CAI?
Burning/stinging (less with azopt)
Blur - more with azopt
SPK, tearing, dryness, photophobia
Allergic reactions (10%) if sulfa allergy
Corneal edema (trusopt)
What is a complaint in 25% of patients who take carbonic anhydrase inhibitors?
Metallic taste
When are carbonic anhydrase inhibitors contraindicated?
Sulfa allergies
Renal and hepatic impairment
Endothelial compromise
Pregnancy
When are carbonic anhydrase inhibitors contraindicated?
Sulfa allergies
Renal and hepatic impairment
Endothelial compromise
Pregnancy
If you need to decrease patients IOP in office, what carbonic anyhyrdrase inhibitor would you use? What percent decrease in IOP does it have? What is the dosing?
Oral Diamox (acetazolamide)
40-50% decrease in IOP
Dose 2 250 mg tablets PO
Rx: 1 250 mg tablet PO every day
What drug can be used to treat macular edema and Idiopathic intracranial hypertension?
Diamox (acetazolamide)
If you had to use an oral CAI for chronic glaucoma, what would you prescribe? What percent IOP decrease?
Methazolamide
30-40% decrease
What are ocular side effects from oral CAIs?
transient myopia
What are systemic side effects from oral CAI
Numbness and tingling of fingers, toes
Metallic taste
Tinnitus
